Hymenoptera Anaphylaxis Bibliography

May, 1996

Joe Lex

Joe_Lex@msn.com
  1. Ariue BK. Multiple Africanized bee stings in a child. Pediatrics, 1994;94:115-117. [94277718]

  2. Awai LE, Mekori YA. Insect sting anaphylaxis and beta-adrenergic blockade: a relative contraindication. Ann Allergy, 1984;53:48-49. [84254712]
    Case report: 31 year-old taking propranolol who developed anaphylaxis to a bee-sting. Severe respiratory reaction was refractory to treatment

  3. Barnard JH. Studies of 400 Hymenoptera sting deaths in the United States. J Allergy Clin Immunol, 1973;52:259-264. [74014195]
    Statistics gathered from 400 deaths over 10 years. Primary pathology was respiratory in 69%, with edema and secretions. Vascular incidents accounted for another 24%. The remainder were felt due to CNS events, septicemia, etc.

  4. Bernard AA, Kersley JB. Sensitivity to insect stings in patients taking anti-inflammatory drugs. Br Med J, 1986;292:378-379. [86105094]

  5. Bousquet J, Menardo JL, Michel FB. Allergy in beekeepers. Allergol Immunopathol (Madr) 1982;10:395-398. [83149518]
    Beekeepers represent a high risk group for allergic disorders. They often have bee-venom specific IgE and all of them have very high titers of bee-venom specific IgG.

  6. Brown H, Bernton HS. Allergy to the Hymenoptera. V. Clinical study of 400 patients. Arch Intern Med, 1970;125:665-669. [70157421]
    400 random, consecutive patients with "consitutional reaction" to insect sting. Family history of inhalant allergy was positive in 46%, but only 17% reported family history of reaction to insect bites. Incidence of sting: yellow jacket > wasp > honeybee > hornet > bumble bee > sweat bee

  7. Chipps BE, Valentine MD, Kagey-Sobotka A, et al. Diagnosis and treatment of anaphylactic reactions to Hymenoptera stings in children. J Pediatr, 1980;97:177-184. [80251158]
    44 children (mean age 9.6 years) with prior reactions were immunized over 15 weeks and subjected to in-hospital (!) sting; there was a 3% reaction rate. Twenty were re-stung after one year of maintenance therapy; there was a single mild, delayed reaction.

  8. Day JH, Buckeridge DL, Welsh AC. Risk assessment in determining systemic reactivity to honeybee stings in sting-threatened individuals. J Allerg Clin Immunol, 1994;93:691-705. [94216645]
    Hypothetical risks were assigned on the basis of several diagnostic parameters (skin tests) and previously affected individuals were challenged by a live honeybee. Of the 70 subjects at low-risk, only 3 (4.3%) experienced mild systemic reactions. Of the 11 in the highest risk category, 8 (72.7%) experienced systemic reactions, of which 5 were severe.

  9. de Groot H, de Graaf-in 't Veld C, van Wijk RG. Allergy to bumblebee venom. I. Occupational anaphylaxis to bumblebee venom: diagnosis and treatment. Allergy, 1995;50:581-584. [96051066]
    Six beekeepers with occupational anaphylaxis. Three changed their occupations. The others started immunotherapy with newly purified bumblebee extract. After 1 year of treament, clinical benefit could be demonstrated in 2 patients.

  10. Elgart GW. Ant, bee, and wasp stings. Dermatol Clin, 1990;8:229-236. [90284099]
    Dermatologists should institute appropriate therapy and avoidance.

  11. Engrav MB, Zimmerman M. Electrocardiographic changes associated with anaphylaxis in a patient with normal coronary arteries. West J Med, 1994;161:602-604. [95159517]

  12. Ewan PW. Route of administration of adrenaline for the treatment of anaphylactic reactions to bee or wasp stings [letter; comments]
    Clin Exp Allergy, 1991;21:753-756. [92136171]


  13. Feigenbaum BA. Insect-sting challenges -- all risk and no benefit? [letter]
    J Allergy Clin Immunol, 1995;96:704-705. [96080220]

  14. Fisher MM, Bowey CJ. Urban envenomation. Med J Aust, 1989;150, 695-698. [89281220]
    Over a 12 year period, 61 patients were admitted to this Australian hospital with envenomation from snakes, spiders, ticks, or bees. All patients with severe envenomations showed symptoms within 30 minutes, and all patients survived.

  15. Ford RP, Dawson KP. Is there a place for bee venom desensitization in children? Aust N Z J Med , 1987;17:85-91. [87298184]

  16. Frazier CA. Medical emergencies and the law. Leg Aspects Med Pract, 1978;6:(Mar) 44-47. [78176105]

  17. Golden DB, Valentine MD. Insect sting allergy. Ann Allergy, 1984;53:444-449. [85070376]

  18. Golub JR, Kaplan SR, Mascia AV. Stinging insect hypersensitivity. Safety and efficacy of venom immunotherapy. N Y State J Med, 1984;84:66-68. [84143066]

  19. Graft DF, Schuberth KC. Hymenoptera allergy in children. Pediatr Clin North Am, 1983;30:873-876. [84015061]

  20. Gupta S, O'Donnell J, Kupa A et al. Management of bee-sting anaphylaxis. Med J Aust, 1988;149:602-604. [89070363]
    Retrospective case analysis found improper use of adrenaline, overuse of steroids, and lack of awareness of the need for volume replacement in hypotensive shocked patients.

  21. Harvey P, Sperber S, Kette F et al. Bee-sting mortality in Australia. Med J Aust, 1984;140:209-211. [84117118]
    From 1960 to 1981, only 25 deaths due to bee sting were reported. The majority were men over 40, with none in individuals aged 6 to 19 years.

  22. Jones MB, Armitage JO, Stone DB. Self-limited TTP-like syndrome after bee sting. JAMA, 1979;242:2212-2213. [80029965]


  23. Lantner R, Reisman RE. Clinical and immunologic features and subsequent course of patients with severe insect-sting anaphylaxis. J Allergy Clin Immunol, 1989;84:900-906. [90094921]
    Evaluated 158 patients with severe reaction (hypotension, loss of consciousness, throat/laryngeal edema, marked respiratory distress). Male - 118, female - 40. Age range 3 to 80 years (mean 29.7). History of atopy in 20%. The subset of 45 with LOC were older, had increased incidence of cardiac disease and beta-blocker use, stings in the head, and re-stings. There were no statistically significant characteristics, including age, that predicted severe venom anaphylaxis.

  24. Lessof MH, Sobotka AK, Lichtenstein LM. Protection against anaphylaxis in hymenoptera-sensitive patients by passive immunization. Monogr Allergy, 1977;12:253-256. [78031007]
    Passive administration of specific immunoglobulin led to transient rise in antiphospholipase IgG and a "very diminished" response to bee venom. Authors do NOT propose this as a routine mode of therapy in insect allergy.

  25. Lichtenstein LM, Valentine MD, Sobotka AK. A case for venom treatment sensitivity to hymenoptera sting. N Engl J Med, 1974;290:1223-1227. [74155023]

  26. Maguire JF, Geha RS. Bee, wasp, and hornet stings. Pediatr Rev, 1986;8:5-11. [89016798]

  27. Meszaros I. Transient cerebral ischemic attack caused by Hymenoptera stings: the brain as an anaphylactic shock organ. Eur Neurol, 1986;25:248-252. [86247746]
    Of 42 studied patients, 30 (71.5%) had some CNS effects. Ten (23.7%) of these patient had no cardiovascular damage, suggesting that the brain is an anaphylactic shock organ.

  28. Miyachi S, Lessof MH, Kemeny DM. Evaluation of bee sting allergy by skin tests and serum antibody assays. Int Arch Allergy Appl Immunol, 1979;60:148-153. [79238560]
    Of 54 subjects with prior anaphylaxis, 38 had IgE antibody to honey bee venom. On skin testing, 30 of 34 had positive tests, but only 26 had positive RAST. Positive skin test seemed to be a good predictor of who was most likely to develop a recurrent anaphylaxis when re-exposed.

  29. Mosbech H. Death caused by wasp and bee stings in Denmark 1960 - 1980. Allergy 1983;38:195-200. [83201955]
    During a 21-year period in Denmark, a total of 26 deaths were caused by wasp or bee stings. Interval between sting and death was 30 minutes to several hours. Only 6 had prior history of adverse reaction to stings.

  30. Nagaratnam N, Husodo H, James WE. Electrocardiographic changes following bee-sting anaphylaxis. J R Soc Med, 1988;81:420-421. [88316887]

  31. Oertel T, Loehr MM. Bee-sting anaphylaxis: the use of medical antishock trousers. Ann Emerg Med, 1984;13:459-461. [84229434]
    Two case reports, both in severe shock. MAST reversed significant hypotension, both survived. Authors recommend use for this and other types of "low-resistance shock."

  32. Ordman D. Bee stings in South Africa. S Afr Med J, 1968;42:1194-1198. [69089947]

  33. Passero MA, Dees SC. Allergies to stings from winged things. Am Fam Physician, 1973;7:(Jun) 74-79. [73187914]


  34. Pearn J, Hawgood S. Bee-sting anaphylaxis in childhood. Med J Aust, 1979;2:228-230. [80077461]
    Children with crescendo reactions to successive stings, especially those with asthma, are significantly at risk, and desensitization is recommended.

  35. Pence HL, White AF, Cost K, et al. Evaluation of severe reactions to sweat bee stings. Ann Allergy 1991;66:399-404. [91241632]
    Of 13 patients who had severe reaction to sweat bee envenomation, 8 were negative to all other insects and 3 were sensitive to honey bees. No reliable antigen is commercially available for diagnosis and treatment.

  36. Peters GA, Karnes WE, Bastron JA. Near-fatal and fatal anaphylactic reactions to insect sting. Ann Allergy, 1978;41:268-273. [79060367]
    Two patients experienced anaphylaxis to bee stings with residual encephalopathy. Pathologic studies showed anoxic encephalopathy, suggested it is due to circulatory collapse rather than the brain being a "target organ" in anaphylactic reactions.

  37. Rabson AR. Desensitization of patients with bee venom allergy -- current status. S Afr Med J, 1985;68:853-854. [86070686]
    "Only patients with documented generalized reactions should be considered for therapy."

  38. Raper RF, Fisher MM. Profound reversible myocardial depression after anaphylaxis. Lancet, 1988;1:386-388. [88120880]
    Two patients went into cardiogenic shock from anaphylaxis, confirmed by ventriculography and 2-D echocardiogram. Both required intra-aortic ballon pump. Some contractile depression persisted for several days. At follow-up, both patients had normal cardiac function with no evidence of underlying heart disease.

  39. Reisman RE, Osur SL. Allergic reactions following first insect sting exposure. Ann Allergy, 1987;59:429-432. [88104759]
    "The occurrence of allergic reactions following first sting exposure adds further support to the thesis that some sting reactions are non-IgE mediated." Of 750 patients identified with anaphylaxis, 65 reacted after first sting exposure.

  40. Reisman RE, Livingston A. Late-onset allergic reactions, including serum sickness, after insect stings. J Allergy Clin Immunol, 1989;84:331-337. [89381153]
    Ten patients, age 6 to 78 years, had allergic reactions 1 to 2 weeks after an insect sting. Four of the 10 had serum-sickness-type reactions; 2 others had more serious anaphylactic symptoms, including throat edema.

  41. Reisman RE, Dvorin DJ, Randolph CC et al. Stinging insect allergy: natural history and modification with venom immunotherapy. J Allergy Clin Immunol, 1985;75:735-740. [85235303]
    Of 127 patients receiving venom immunotherapy, there were 87 re-stings in 48 patients, resulting in 2 systemic reactions. In 56 patients who declined immunotherapy, there were 40 re-stings in 28 patients with 14 systemic reactions (35%). In 88 patients who stopped immunotherapy, there were 61 re-stings in 41 patients with 11 systemic reactions (17%).

  42. Reisman RE. Insect sting challenges: do no harm. [letter]
    J Allergy Clin Immunol,1995;96:702-703. [96080217]


  43. Reisman RE. Stinging insect allergy. Med Clin North Am, 1992;76:883-894. [92309992]
    Insect sting anaphylaxis affects about 0.4% of the population. Severe reactions are rare in children. Venom immunotherapy provides almost 100% protection against subsequent re-sting reactions.

  44. Rubenstein HS. Bee-sting diseases: Who is at risk? What is the treatment? Lancet, 1982;1:496-499. [82147400]
    "Death comes unpredictably, and those at risk have not been identified." Immunotherapy has not been proven to prevent death.

  45. Savliwala MN, Reisman RE. Studies of the natural history of stinging-insect allergy: long-term follow-up of patients without immunotherapy. J Allergy Clin Immunol, 1987;80:741-745. [88060180]
    29 patients with anaphylaxis without immunotherapy followed up at 10.1 years after initial sting reaction. There were 25 re-stings in 17 patients, with 3 systemic reactions in 2 patients (12%). In patients with initial urticaria/ angioedema symptoms only, there were 11 re-stings with no reaction. "In many patients, stinging insect allergy is a self-limited process, with loss of clinical sensitivity and immunologic reactivity."

  46. Schuberth KC, Lichtenstein LM, Kagey-Sobotka A, et al. Epidemiologic study of insect allergy in children. II. Effect of accidental stings in allergic children. J Pediatr, 1983;102:361-365. [83138135]
    181 children with non-life-threatening reactions were randomized to treatment (53) or no treatment (128) and followed for two years. There were 28 stings in 17 treated patients with one mild reaction. There were 74 stings in 47 untreated patients, with 8 mild reactions (p=NS). No reaction was more serious than the original. The majority of children, treated and untreated, showed decreased skin test sensitivity over time.

  47. Schumacher MJ, Tveten MS, Egen NB. Rate and quantity of venom from honeybee stings. J Allergy Clin Immunol, 1994;93:831-835. [94238064]
    In shaved rabbit models, it was shown that 90% of venom sac contents was delivered within 20 seconds and venom delivery was complete within 1 minute.

  48. Schumacher MJ, Egen NB. Significance of Africanized bees for public health. A review. Arch Intern Med, 1995;155:2038-1043. [96011560]
    Africanized bees are endemic in parts of Texas and Arizona. Treatment of severe toxic reactions to multiple stings usually involves management of shock, hypoxia, and other effects of organ damage. New approaches, such as production of a bee antivenom and hemodialysis (!), require further study. Persons previously sensitized should receive venom immunotherapy, possibly given more intensely and for longer periods than currently recommended.

  49. Schwartz HJ. Acute allergic disease in a hospital emergency room: a retrospective evaluation of one year's experience. Allergy Proc, 1995;16:247-250. [96149805]
    Of 23,647 ER visits, 326 (1.4%) represented an allergic reaction. Only 13/48 (27%) of bee sting allergic patients were given self-injectable epinephrine and 6/48 (12.5%) were referred to an allergist. None of the other 165 patients was referred to an allergist.

  50. Settipane GA, Chafee FH, Klein DE et al. Anaphylactic reactions to Hymenoptera stings in asthmatic patients. Clin Allergy, 1980;10:659-665. [81112606]
    587 cases of generalized reaction. Incidence of atopy was 22%, about the same as general population. Asthmatic patients did not have increased risk of developing anaphylaxis. The asthmatics who did, however, had more severe reactions, especially dyspnea. Authors propose this due to endogenous histamine release leading to acute bronchospastic reaction.

  51. Soreide E, Buxrud T, Harboe S. Severe anaphylactic reactions outside hospital: etiology, symptoms and treatment. Acta Anaesthesiol Scand,1988;32:339-342. [88278952]
    27 patients transported by helicopter in 5-year period, all with signs of respiratory or circulatory failure. Three (11%) needed intubation. Death occurred in both patients whose time from onset of symptoms to transport was >45 minutes.

  52. Sorenson HT, Nielsen B, Ostergaard Nielsen J. Anaphylactic shock occurring outside hospitals, Allerg,1989;44:288-290. [89285598]
    Over a 13 year period, 20 cases of anaphylaxis were found in this Danish hospital's catchment area, 8 due to bee or wasp stings. Conclusion: "Anaphylaxis rarely occurs outside hospital."

  53. Thomas OC, McGovern JP. Hymenoptera insect hypersensitivity. J Sch Health,1974;44:271-276. [74166661]

  54. Tunget CL, Clark RF. Invasion of the 'killer' bees. Separating fact from fiction. Postgrad Med, 1993;94 (Aug) 92-94, 97-98, 101-102. [93341967]
    Multiple stings (more than 50) may result in a reaction similar to anaphylaxis from the increased toxin load. Stingers should be removed by gentle scraping.